Provider Demographics
NPI:1619499076
Name:AULD, ANTENNIE D (NP-C)
Entity Type:Individual
Prefix:
First Name:ANTENNIE
Middle Name:D
Last Name:AULD
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11134 LUSCHEK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2434
Mailing Address - Country:US
Mailing Address - Phone:513-827-9274
Mailing Address - Fax:513-818-9960
Practice Address - Street 1:11134 LUSCHEK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2434
Practice Address - Country:US
Practice Address - Phone:513-827-9274
Practice Address - Fax:513-818-9960
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020969363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner